Healthcare Provider Details

I. General information

NPI: 1508804485
Provider Name (Legal Business Name): JEFFREY P MCCOY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 CHURCH ST
SHENANDOAH IA
51601-2301
US

IV. Provider business mailing address

813 CHURCH ST
SHENANDOAH IA
51601-2301
US

V. Phone/Fax

Practice location:
  • Phone: 712-246-5954
  • Fax: 712-246-3269
Mailing address:
  • Phone: 712-246-5954
  • Fax: 712-246-3269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6219
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: